Sulodexid je látka patřící do skupiny glykosaminoglykanů (spolu s hepariny). Ve srovnání s jinými glykosaminoglykany má sulodexid větší antitrombotické vlastnosti při současně nižším riziku krvácení a na rozdíl od heparinů je možné jeho podávání jak parenterálně, tak perorálně. Preparát má prokázány mnohočetné farmakodynamické účinky. Klinickými studiemi je dobře doložena efektivita preparátu u pacientů s klaudikacemi. Evidence účinku je také u nemocných s nejtěžšími případy chronické žilní nedostatečnosti, včetně pacientů s aktivními bércovými vředy. V případě pozitivního výsledku probíhajících studií bude možné jako další indikaci přidat sekundární prevenci žilní trombózy., Sulodexide is a compound belonging to the group of glycosaminoglycans (together with heparins). In comparison with other glycosaminoglycans, sulodexide has stronger antithrombotic properties and a lower risk of bleeding, and unlike heparin, it can be administered both parenterally and orally. Multiple pharmacodynamic effects of the preparation have been demonstrated. Clinical studies have documented the effectiveness of the drug in patients with claudication. There is evidence of its effect also in patients with the most severe cases of chronic venous insufficiency, including patients with active leg ulcers. In the case of a positive outcome of the ongoing studies, secondary prevention of venous thrombosis will be added as another indication., and Roztočil K.
Interventions of paediatric obstructive sleep apnea syndrome are complex, varied and multidisciplinary. The goal of the treatment is to restore optimal breathing during the night and to relieve associated symptoms. Evidence suggests that the surgical intervention with removal of the tonsils and adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. However, post-operative persistence of this syndrome in paediatric population is more frequent than expected, which supports the idea of the complexity of this syndrome. Adenotomy alone may not be sufficient in children with OSAS, because it does not address oropharyngeal obstruction secondary to tonsillar hyperplasia. Continuous positive airway pressure can effectively treat this syndrome in selected groups of children, improving both nocturnal and daytime symptoms, but poor adherence is a limiting factor. For this reason, CPAP is not recommended as first-line therapy for OSAS when adenotonsillectomy is an option. It is now being investigated the incorporation of nonsurgical approaches for milder forms and for residual OSAS after surgical intervention. Althought adeno-tonsillar hypertrophy is the most common for OSAS in children; obesity is emerging as an equally important etiological factor. Therefore an intensive weight reduction program and adequate sleep hygiene are also important lifestyle changes that may be very effective in mitigating the symptoms of this syndrome. Pharmacological therapy (leukotriene antagonists, topical nasal steroids) is usually use for mild forms of OSAS and in children with associated allergic diseases. Special orthodontic treatment and oropharyngeal exercises are a relatively new and promising alternative therapeutic modality used in selected groups of children with OSAS. and A. Šujanská, P. Ďurdík, J. Rabasco, O. Vitelli, N. Pietropaoli, M. P. Villa
Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient's quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage. and T. Kučera, P. Šponer, J. Šrot
Suspenze přední poševní stěny spočívá v rekonstrukci nativní tkáně vaginální cestou. Cílem operace je korekce stresové močové inkontinence, k níž došlo v důsledku hypermobility močové trubice, a případně souvisejícího prolapsu přední poševní stěny jakéhokoli stupně. Ideálním kandidátem pro tento výkon je pacientka s laterální cystokélou (1. a 2. stadium). Operace může být indikována rovněž u pacientek s cystokélou závažnějšího stupně, v tomto případě je však nezbytná další rekonstrukce v podobě suspenze klenby poševní a korekce posteriorního kompartmentu (enterokéla, rektokéla). V našem článku popisujeme techniku rekonstrukce a uvádíme naše počáteční (dosud příznivé) zkušenosti. Operace je krátká (trvá přibližně jednu hodinu), je spojena s minimální morbiditou a nemá žádný vliv na mikční funkci. Operace neovlivňuje hloubku ani délku pochvy – po zhojení sutury se tedy pacientka může vrátit k sexuální aktivitě. Prof. Zimmern (UT Southwestern Medical Center, Dallas, USA) prezentoval na poslední konferenci SUFU a AUA dlouhodobé výsledky po 15 letech., The anterior vaginal wall suspension is a native tissue repair procedure done vaginally to correct stress urinary incontinence secondary to urethral hypermobility and any associated degree of anterior vaginal wall compartment prolapse. The procedure is ideally suited for women with lateral defect cystocele (stages I and II). The procedure can be applied for more advanced degrees of cystocele, but additional repairs will be necessary including vault suspension and posterior compartment repairs (enterocele, rectocele). The technique of the procedure is reported herein, along with our early experience which has been favorable so far. The procedure is short (around one hour), with limited morbidity and no impact on voiding function. Vaginal depth and size are not compromised; so sexual activity can be resumed once the vaginal suture lines have healed. Long‑term data at 15 years has been reported at the last SUFU and AUA meetings by Dr Zimmern from UT Southwestern Medical Center in Dallas., and Gulpinar O., Zimmern P.